Patient is clinically node positive: clinically suspicious axillary lymph node(s) by axillary US or exam unless biopsied and found to be negative

Patient has stage IV metastatic disease

* Patients with oligo-metastatic disease who are being treated with curative intent per the treating physician will not be excluded if all other eligibility criteria are met

Breast tumor size is > 3.0 cm

Positive non-axillary sentinel nodes or evidence of suspicious supraclavicular, infraclavicular, or internal mammary nodes by imaging or physical exam, unless biopsied and found to be negative for tumor

Evidence by physical examination or mammography of other suspicious masses, densities, or microcalcifications in either breast, unless biopsied and found to be benign

Paget's disease of the nipple

Previous breast radiation on ipsilateral side

Any prior treatment with radiation therapy or chemotherapy for the current breast cancer diagnosis prior to registration

Patients with significant psychiatric illness that would preclude them from adhering to the protocol in the judgement of the treating clinician

BMI < 21 at the time of study enrollment